A service of the California Health Care Foundation

State: Autism Therapy a Medi-Cal Benefit

State officials said yesterday autism therapy clearly is a covered Medicaid benefit, and they hope to submit a state plan amendment by Sept. 30 to start the process to make it a Medi-Cal benefit for those under age 21.

According to René Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, Medi-Cal children are entitled to applied behavior analysis — known as ABA therapy.

“Right now we’re working on the development of a state plan amendment. We want to engage the stakeholders in developing that,” Mollow said. “We’re looking to have it submitted at the end of September, and having it retroactive to July 1.”

DHCS received a standing ovation yesterday at a Senate hearing when Senate President Pro Tempore Darrell Steinberg (D-Sacramento) announced the news.

“Today’s announcement cements the original vision of SB-946 by ensuring that all kids, regardless of their insurance status, will have access to life-changing treatment,” Steinberg said in a written statement. “At the time, we recognized that SB-946 was a significant advance, but an incomplete advance. The circle has been completed.”

Medi-Cal children now receiving ABA therapy likely will have that care retroactively paid for by Medi-Cal.

Mollow said the state also is in touch with CMS on technical clarifications of the federal guidance states recently received from CMS officials — guidance that led to implementation of autism therapy under Medi-Cal, she said.

“We plan to have a formal meeting with stakeholders on Aug. 29 regarding this policy we’re looking to implement,” Mollow said.

The new policy should start by the beginning of next year, Mollow said. Till then, there is a lot to do to develop the provider network and reimbursement rates, she said.

“And the question is what to do in the interim, when people are looking to get services now,” Mollow said.

Autism advocates were understandably delighted.

“We’re thrilled that the state is moving in this direction, and very encouraged by the steps they’re taking,” said Kristin Jacobson, president of Autism Deserves Equal Coverage, an advocacy group based in Burlingame. “We want to work with them to implement this as expeditiously as possible.”

Jacobson said roughly 6,000 Medi-Cal children could benefit from ABA therapy who don’t currently receive it.

 

“About half the kids in the state are insured by Medi-Cal. Some are dual covered with private health plans,” Jacobson said. “We estimated about 10,000 kids in Medi-Cal need ABA therapy and probably 4,000 of them are already served by [the Department of Developmental Services]  so maybe 6,000 additional children.”

 

That’s definitely an estimate, she said, “but not a small number.”

“It’s important for families to know this is happening,” said Karen Fessel, executive director of the Autism Health Insurance Project. “I’m cautiously optimistic. I do believe this is going to happen, and it’s a question of when.”

Categories: Capitol Desk, Medi-Cal

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